术中头部体位对强直性脊柱炎胸腰椎后凸畸形患者后路截骨矫形时唤醒试验的影响

The effect of head positions on the wake-up test in pedicle subtraction osteotomy for thoracolumbar kyphosis sencondary to ankylosing spondylitis

目的：探讨术中头部体位对强直性脊柱炎（ankylosing spondylitis, AS）胸腰椎后凸畸形患者经椎弓根椎体截骨（pedicle subtraction osteotomy,PSO）时唤醒时间及苏醒质量的影响。方法：选取2005年5月～2012年11月在我院行PSO的35例AS胸腰椎后凸畸形患者，分为头部抬高体位组（抬高组）和头部未抬高体位组（未抬高组）。两组患者麻醉方式、麻醉诱导用药和维持用药均相同，同时用脑电双频指数（bispectral index，BIS）监测麻醉深度使其保持一致，比较抬高组和未抬高组患者PSO术中唤醒时间及苏醒质量（采用Imani等分级标准分级）。结果：所有患者术中唤醒试验均成功。抬高组患者的术中唤醒时间为24．9±5．13min，未抬高组为39．8±9．41min，两组差异有显著性（P〈0．05）。唤醒试验中，抬高组1例、未抬高组5例患者突然睁眼，并伴有四肢不自主活动，苏醒质量为2级，其余29例患者苏醒质量均为1级。抬高组患者术后颜面部及球结膜水肿的外观表现均较未抬高组轻。结论：AS胸腰椎后凸畸形患者PSO术中头部抬高体位可以缩短术中唤醒时间、提高患者的苏醒质量。

Objectives： To investigate the effect of different head positions on wake-up time and the quality of wake-up test in pedicle subtraction osteotomy （PSO） for thoracolumbar kyphosis caused by ankylosing spondylitis（AS）. Methods： Between May 2005 and November 2012, 35 AS patients undergoing PSO were in- cluded in this study. Patients were divided into two groups： the head elevated group（elevated group） and the non-elevated group（non-elevated group）. The same protocol of anesthesia, including the inducing and main- taining medications were applied for all patients. Bispectral index （BIS） was used to monitor the depth of anesthesia and to keep it consistent between the two groups. Wake-up time and the quality of wake-up （e- valuated using a 3-point rank scale） were compared in these two groups. Results： Wake-up tests were suc- cessful in all cases. Patients in head elevated group had significantly shorter wake-up time compared with non-elevated group（24.9±5.13min vs 39.8±9.41min, P〈O.05）. During the wake-up tests, one patient in elevated group and five patients in non-elevated group suddenly opened their eyes with spontaneous limbs movement. For whom, the quality of wake-up test was the grade Ⅱ, whereas the remaining 29 patients were grade I . The appearance of facial edema and chemosis in patients of elevated group was milder than non-elevated group. Conclusions： Elevating the head position can shorten wake-up time and improve the quality of wake- up test during the procedure of PSO for AS patients with thoracolumbar kyphosis.